Document Detail

Management of peripheral arterial disease.
MedLine Citation:
PMID:  15705252     Owner:  NLM     Status:  MEDLINE    
Peripheral arterial disease (PAD) may be asymptomatic, may be associated with intermittent claudication, or may be associated with critical limb ischemia. Coronary artery disease (CAD) and other atherosclerotic vascular disorders may coexist with PAD. Persons with PAD are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from CAD. Modifiable risk factors such as cessation of cigarette smoking and control of dyslipidemia, hypertension, and diabetes should be treated. Statins reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in persons with PAD and hypercholesterolemia. Antiplatelet drugs such as aspirin or clopidogrel, especially clopidogrel, and angiotensin-converting enzyme inhibitors should be given to all persons with PAD. beta-Blockers should be given if CAD is present. Exercise rehabilitation programs and cilostazol improve exercise time until intermittent claudication. Indications for lower-extremity angioplasty, preferably with stenting, or bypass surgery are 1) incapacitating claudication in persons interfering with work or lifestyle; 2) limb salvage in persons with limb-threatening ischemia as manifested by rest pain, nonhealing ulcers, and/or infection or gangrene; and 3) vasculogenic impotence. However, amputation should be performed if tissue loss has progressed beyond the point of salvage, if surgery is too risky, if life expectancy is very low, or if functional limitations diminish the benefit of limb salvage.
Wilbert S Aronow
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Cardiology in review     Volume:  13     ISSN:  1061-5377     ISO Abbreviation:  Cardiol Rev     Publication Date:    2005 Mar-Apr
Date Detail:
Created Date:  2005-02-11     Completed Date:  2005-07-15     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9304686     Medline TA:  Cardiol Rev     Country:  United States    
Other Details:
Languages:  eng     Pagination:  61-8     Citation Subset:  IM    
Divisions of Cardiology and Geriatrics, Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY 10595, USA.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Aspirin / therapeutic use
Intermittent Claudication / therapy
Peripheral Vascular Diseases / drug therapy,  physiopathology,  therapy*
Platelet Aggregation Inhibitors / therapeutic use
Risk Factors
Ticlopidine / analogs & derivatives*,  therapeutic use
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel

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